PCs are complex tumors which require a multidisciplinary approach and long-term follow-up.

ENETS consensus recommendations for the standards of care in neuroendocrine neoplasms (NEN) concerning follow-up and documentation are considered in this review. The documentation of patients with NEN should include the most relevant data characterizing an individual patient from the first contact with his/her physician/hospital until his/her last presentation during follow-up. It is advocated that follow-up occurs in specialized NEN centers with regular NEN tumor boards with expert panels. The follow-up should be in accordance with the ENETS consensus guidelines from 2011 and 2016, the present and coming WHO classification and ENETS/UICC recommendations for TNM staging. The recommendations for follow-up in patients with thymic, bronchopulmonary and gastroenteropancreatic NEN are given in Table 1. However, it should be stressed that evidence-based studies for follow-up are largely missing.

A 44 year old male patient presented with severe hypertension. The diagnostic work-up revealed elevated levels of plasma renin activity (about 10 times the upper limit of normal) in the presence of normal plasma aldosterone levels and serum potassium concentrations. Renovascular disease was excluded by angiography. Selective renal vein sampling did not show any renin gradient. CT-scans of the abdomen demonstrated normal morphology of the kidneys and adrenals but revealed a big mass in the pancreatic corpus and tail with infiltration of the splenic vein and the presence of enlarged local lymph nodes. The endocrine nature of the pancreatic mass was further supported by a positive octreotide scintigraphy scan. Surgical removal of the tumor by left sided pancreatectomy combined with splenectomy resulted in rapid normalization of elevated renin concentrations as well as blood pressure. Histological examination of the tumor tissue revealed the presence of a neuroendocrine pancreatic carcinoma. Highly (x 70) elevated renin levels were detected by radioimmunoassay in the tumor tissue. To our knowledge this is the first renin-producing neuroendocrine pancreatic carcinoma described in the literature. The present paper describes the case in detail and reviews the available literature on clinical symptomatology, diagnosis and treatment of renin-producing tumors.

pancreaticoduodenctomy(PD) and distal pancreatectomy(DP). We aimed to investigate the difference of fistula rates after pancreatectomies between the different techniques Methods: We collected the datas of 500 patients that were operated between 2009e2014 at Ege University. Duct to mucosa pancreaticojejunostomy(PJ) anastomosis was performed after all PDs. The pancreatic parenchyma stump closure was achieved either with a stappler or hand sewn. Fistula was defined according to the definition of International Study Group on Pancreatic Fistula (ISGPF) (Grade A,B,C). Fisher exact test was used to determine the difference of the fistula rates between the stappled and hand sewn distal pancreatectomies. Chi-square test was used for determining the difference between the presence of the stent in the fistula rates after pancreaticoduodenectomies. Results: 247 of the patients were male and 253 of them were female with the average age of 60,3 years. Of the 500 patients, 311 were performed PD, 153 were performed DP, 32 were performed enucleation and 4 were performed duodenum preserved total pancreatectomy. Stent was used in 68 of the 311 PD's. Pancreatic parenchyma stump closure was achieved by using stappler in 7 of the 153 DP's. Fistula was determined in 14 of 68 patients that stent was placed in PJ where in 9 of 243 that stent was not used in PJ (p < 0,01). Fistula was determined in 4 of 7 patients whose stump closure was achieved by using stappler where 6 of 146 patients with hand sewn stump after DP (p < 0,01). Conclusions: We determined that using intraductal pancreatic stent while performig PJ anastomosis raises POPF rate. Hand sewn closure of pancreatic stump after DP has lower rates of POPF than stapled closure of the parenchyma.

No abstract